Model: Uneven MitraClip Not Behind Recurring MR

Clipping more posterior than anterior tissue not linked to leaflet stress

Uneven MitraClip placement did not increase leaflet stress, making it unlikely to be complicit in mitral regurgitation recurrence, according to a computer model.

Having more posterior than anterior leaflet tissue clipped by the device still eased leaflet stress compared with baseline, Mark B. Ratcliffe, MD, of the San Francisco VA Medical Center, and colleagues, reported online in JAMA Surgery.

End-systolic leaflet stress rose in line with increasing systolic blood pressure for all percutaneous clip configurations in the finite element modeling with a simulated heart.

"Further studies are indicated to examine these findings in a variety of mitral regurgitation pathologies, including functional mitral regurgitation. As novel percutaneous mitral regurgitation therapies emerge, finite element modeling as used here can be a powerful tool to examine their effect on the tissues of the heart," Ratcliffe's group wrote

The investigators conducted their finite element model study using LS-Dyna software. The MitraClip simulations were based off images taken of an individual with isolated posterior mitral valve prolapse.

"Based on this single-patient model, the common procedural occurrence of uneven MitraClip application does not result in increased leaflet stress and therefore should not increase the incidence of recurrent mitral regurgitation," Ratcliffe's group concluded.

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